Constraint choice in revision total knee arthroplasty depends on the stability of the collateral ligaments and on the severity of bone loss, but the least degree of constraint necessary is recommended. The purpose of this retrospective matched-paired study was to compare clinical results, radiographic outcome and the survival of a stemmed medial pivot revision implant in aseptic revision TKA vs. medial pivot implant in primary TKA.
Records were reviewed for 69 cases of aseptic revision TKA using Advance® Medial Pivot Stemmed Revision Knee system between 2002 and 2016. These patients were then matched in a 12 ratio control group of patients who received a primary TKA with Advance® Medial Pivot system. American Knee Society Score and Visual Analogue Scale pain score were recorded. Alignment, loosening, and incidence of radiolucent lines were evaluated on X-rays. Implant survival was assessed by Kaplan-Meier survival analysis.
The primary TKA group had significant superior AKSS clinical and functional score at baseline (52.3 and 68.2 points, respectively) and at last follow up (84.6 and 68.6 points) compared with the revision TKA group (47.9 and 40.9 points; 78.4 and 59.9 points; P&lt;0.05). No significant difference was observed in the mean change from baseline to last follow up of AKSS score between the two groups (P&gt;0.05). Radiographical outcome and implant survival were similar in the two groups (P&gt;0.05).
The authors support the use of this revision system in knees with collateral ligaments competence and mild-to-moderate bone defect.
The authors support the use of this revision system in knees with collateral ligaments competence and mild-to-moderate bone defect.The purpose of the study was to investigate the long-term outcomes of the all-inside arthroscopic medial reefing (AAMR) procedure for patellar instability and the factors that affect successful outcome.
In this retrospective study, AAMR with suture was performed in 16 knees of 15 patients who had at least one patellar dislocation and did not experience a decrease in pain and who did not have a major radiological bony abnormality. Preoperatively, Tegner and Lysholm scales were used; for the final evaluation Tegner, Lysholm, Kujala and Knee injury and Osteoarthritis Outcome Score (KOOS) were used.
The average age of the patients at the time of operation was 18years (range 11-36years). The average follow-up time was 118.3months (range 85-143months). Six of the 16 knees (37.5%) exhibited re-dislocation. Preoperatively, the mean Lysholm and Tegner were 66.5 and 4.0, respectively; and postoperatively increased to 89.3 (P=.001) and 4.66, respectively. At the final follow-up, mean Kujala was 89.3 (good), and mean KOOS was 91.4. In all patients with re-dislocation, fewer than four knots were used, and none of the patients with four knots exhibited re-dislocation. Re-dislocations occurred in two, two, one and one patients at two, three, five and eight years, respectively.
The AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.
The AAMR technique is associated with minimal incisional scarring and an increase in functional scores. It is also associated with a high risk of re-dislocation compared with other methods. https://www.selleckchem.com/Bcl-2.html If the technique still needs to be used, despite the high re-dislocation rate, at least four knots should be applied.Increasing demand for total knee arthroplasties (TKA) has been targeted by legislation to minimize costs and maximize outcomes. Home discharges reduce costs, and it is important to determine patient variables associated with this discharge disposition. We explored non-modifiable and modifiable factors associated with non-home discharges to determine what patient specific factors require attention.
This retrospective study included 171,903 National Surgical Quality Improvement Program (NSQIP) patients between 2011 and 2016. Patient specific variables and discharge destinations included home, short-term nursing facilities (SNF), not home, and rehabilitation. Chi-squared analyses and analyses of variance (ANOVA) were conducted for categorical and continuous data, respectively. Multinomial regression model was utilized to assess associations between discharge destination and patient specific variables.
Every year increase above the mean age (66?years) was associated with a nine percent (p?&lt;?.001) and six percent (p?&lt;?.001) increased odds for discharge to SNF or rehabilitation, respectively, compared to home discharges. Every 10% increase in BMI from the mean was associated with a 10% increase in discharge to both SNF and rehabilitation (p?&lt;?.001 for both).
With increasing demands for TKAs and expenditures to Medicare, evaluating factors that impact patient discharge can help optimize costs and outcomes of TKA procedures. Arthroplasty surgeons can benefit by recognizing these correlations and exploring reductions to non-home discharges through pre-operative patient optimization. Future studies should evaluate the economic cost potential associated with optimizing routine home discharge in TKA patients.
IV.
IV.The aim of the present study was to confirm the effectiveness of adding nanohydroxyapatite (NHA) to a heterologous bone graft in open-wedge high tibial osteotomy (OWHTO) by measuring the bone density via multislice computed tomography (CT) of the tibial osteotomy gap in a mid-term follow-up (five years).
Twenty-six patients undergoing OWHTO were randomly assigned to two groups a pure graft group (Group A), in which the osteotomy gap was filled with only heterologous bone graft, and an NHA group (Group B), in which the osteotomy gap was filled with heterologous bone graft and NHA. CT was performed within one week of the operation, after two months, after 12months and after five years. CT volume acquired in Hounsfield units (HU) was measured on three planes.
The normal bone density was 110.2±11.7HU. The value of mean density at five years in Group A was 296.8±81.8HU, while in Group B, it was 202.2±45.1HU, showing a density more similar to normal bone and greater bone uniformity inside the osteotomy. The difference between the two groups was statistically significant (p&lt;0.